Provider Demographics
NPI:1154530772
Name:NAU, JEREMY RYAN (BA)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:RYAN
Last Name:NAU
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3943 E 28TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50317-4225
Mailing Address - Country:US
Mailing Address - Phone:515-883-0185
Mailing Address - Fax:
Practice Address - Street 1:3943 E 28TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50317-4225
Practice Address - Country:US
Practice Address - Phone:515-883-0185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor